I have muscle tension dysphonia, could I have TMS?

I'm new to this forum. I've ordered the Mind/Body prescription book by Dr John Sarno. While I wait for its arrival I thought it worth asking if any of you have any experience of TMS affecting the voice?

I've been diagnosed with Muscle Tension Dysphonia (MTD). When I speak its like I'm trying to talk while someone is standing on my throat. I have had this building up for three years and its been acute for about a year. I've had doctors, surgeons and voice therapists trying to determine what is wrong. They reckon its MTD. The only treatments they offer are voice therapy and cognitive behavioural therapy (CBT). I've been attending voice therapy and doing the exercises for about a year to no effect. It can help me vocalise but it doesn't last. I'm on the waiting list for CBT.

I can sing and I can do silly voices. I can't talk in what was my normal voice.

This has become a horrid and all-consuming nightmare. It affects my whole life, at work and at home.

I could go on about my woes. There is no need. I feel that many of you will understand the feelings I have been experiencing. I want to know if this sounds like TMS to you lot. Has anyone had it affect their voice? Did Sarno's work help?

I look forward to reading your responses should you get the time to read my post.

Welcome to the forum. You have an interesting issue that had me recall a memory of my own. Perhaps it might help you.

When I was younger, I used to sing quite a bit. I had a pretty good singing voice and was known for "belting it out". I had a big performance scheduled when suddenly I couldn't talk, let alone sing. I was panicked, and so my was my family. My dad (my hero) found me a voice teacher for advice and she suggested several things that brought my voice back to performance level. I was in high school and looking back, I think I was terrified of this performance and promptly lost my voice. I was also insecure and looking for attention at that time from my dad.

You have seen a doctor which we always recommend you do, and you say nothing has happened. You can do "silly voices". I found that part interesting as perhaps there is something blocking you from "speaking your truth." Perhaps it's in your work or relationship.

It certainly can't hurt to look into Dr. Sarno's books and suggestions. There is also a Structured Program on the wiki if after you've read the book, you see yourself. It is a wonderful exploration that will help you to find the answers you seek. It's hard to say whether or not this is TMS/PPD, but exploration of the issue through the book and also the wiki can be really helpful. You'll know. Most everyone with TMS/PPD sees themselves soon after reading the book or poking around the wiki.

I can't tell you that you have TMS/PPD, but I do think you're moving in the right direction.

As you explore the wiki - and if you have any further questions, please come back and ask. There is always someone to help with your questions and support you through this issue.

Hi Jake, a few years ago I had a similar problem. I went through a period at a previous job unable to speak when interviewing clients. When I opened my mouth to speak I would start to choke. I had to apologise profusely on many occasions. I would get very frustrated and anxious. At the time I was in a job that I liked but where I felt unsupported by my superiors. As a result I lacked confidence in my abilities and this is most likely why when I tried to speak, I often couldn't get the words out. I changed jobs eventually. Still working in an advisory position I was by this time much better supported and felt more confident. Whenever I started to choke I would remain calm. I always kept some water and some candy nearby. Eventually I no longer experienced any choking. This was all before I had heard of Dr Sarno so I guess I already had some awareness of the role of stress and fear in physical symptoms.

When did this all start with you? What was going on in your life at the time?

You mention being able to use your voice to sing and talk in silly voices. Whenever you witness these 'exceptions to the rule', you can bet there is something going on that is not physical.

Beach Girl mentioned the Structured Educational Program on the wiki (tmswiki.org). I would like to double-emphasize that as a great place to start. I had many different TMS symptoms over many years. Reading my first Dr. Sarno book made sense to me, but it wasn't until I started doing the SEP (and taking it seriously) that I started having a noticeable reduction of symptoms. I'm 90-100% symptom-free most of the time now (I could be 100% if I practiced more mindfulness!). In any case, it was a real life-changer.

You've been recommended for CBT - so your medical practitioners already think that the problem could be emotional. And you already know that emotionally-based physical symptoms, by Dr. Sarno's definition, are TMS. Also called by some practitioners MBS (Mind-Body Syndrome), or sometimes PPD (Psychophysiologic Disorders) or, to use a phrase that has fallen out of favor: psychosomatic illness. Take your pick - we're not talking about a black & white condition like, say, a broken bone, it's all kind of squishy when we're talking about the brain - literally :^)

What I'm trying to say is: if the medical pros think that CBT could help, then you might as well feel free to call it TMS, and I don't think that's a stretch!

One thing you will learn as you study the TMS resources is that CB therapists might not understand the emotional basis of TMS. Many of our members' back stories include trying CBT without a whole lot of significant success. That's not to say that a CB therapist can't include TMS treatment in their practice - it's just that many don't know about it (yet)(!)

Anyway, go ahead and try the Structured Ed Program - it's just reading and journaling, it's free, it can't hurt, and you will be taking action which in itself will feel good.

There's also a page on the wiki devoted to finding a TMS practitioner in your area, and as we discussed today on the Saturday chat, many of them are available to do therapy by phone - strange but true, and many people have found help that way.

Dr. Howard Schubiner is a long time staunch supporter of the PPD / TMS Peer Network and at one point even offered to donate a portion of all proceeds from his online program to our nonprofit. We ended up declining his generous offer because we know how important it is to let the public know that we are completely financially independent of all PPD / TMS practitioners and represent only Peers with PPD / TMS, but the offer was gratefully appreciated (we need people to know that we recommend his program only because it is excellent and not because it diminishes our need to get donations from other sources). Because we are a volunteer run organization, our expenses are extraordinarily low, so it isn't that hard to raise the money that we need. In general, volunteer organizations take an extremely high amount of work to set up (for example, as of today, I've sent 4259 emails from the account that I use for TMS Wiki work. I've pretty much been working on this almost full time for three years), but once you've set them up, you've created something truly amazing. As you can see from the hard work of the volunteer Forum Support Team who run this forum, we've got an amazing team. They're the people with "administrator" or "Forum Support" below their pictures.

Written by Dr. Schubiner on February 20, 2011If you’ve seen the movie, The King’s Speech, you will immediately recognize that the king suffered from a form of Mind Body Syndrome. He had a very difficult childhood, despite (or because of) being a prince. His parents were not present (as was the custom for those days and that class) and his major source of “parental” affection was from his nanny. Unfortunately, his nanny favored his older brother who tormented him and therefore George grew up feeling less worthy, unloved, and unable to assert himself. All of this eventually led to the expression of his underlying emotional conflicts in his stammer. The origin of his stammer was clear (it was the physical manifestation of underlying psychological issues). Why did it persist for so many years? The answer is that it became a learned nerve pathway. That pattern of speech became ingrained into his nervous system over time and that was the natural way that his brain processed the signals when he was required to speak. Of course, the stammer would be more severe under times of stress, but it couldn’t be reversed until he had treatment that helped to uncover the underlying conflicts and conscious application of methods to reverse the nerve pathways.

Stuttering (or stammering, I believe these can be used interchangeably) is quite common in children. I don’t recall this, but my mother told me that I started to stutter right after my sister was born. I guess I was used to being the “prince” in my household until she came along to usurp my parents attention. Fortunately, it didn’t last too long. My mother got me to sing songs (the stutter disappeared during singing) much of the time, gave me extra attention, and the nerve pathways reversed over time.

Stuttering typically begins in childhood, but there is another form of stress-induced speech disorder that usually begins later in life that is similar to stuttering, spasmodic dysphonia. This condition occurs primarily in young adults (ages 30-50) and is more likely to affect women, which is similar to the demographics of those who suffer from Mind Body syndromes, such as headaches, fibromyalgia, back and neck pain, and irritable bowel and bladder syndromes. There is no known abnormality of the vocal cords, per se. The difficulty in speaking is variable, can be made worse with stress, and may not occur during singing or speaking in high pitched voices (when slightly different nerve pathways are activated, as apparently my mother figured out when trying to help my stuttering). Some professional singers suffer from this condition and can have difficulty in singing.

When I have conducted detailed interviews with people with spasmodic dysphonia, the typical pattern emotional events that create MBS are present. We find childhood priming events (such as emotional, physical or sexual abuse, or situations similar to those experienced by the later King George) and triggering events later in life (such as losses, situations that trigger the “danger” signals, etc.) that produce the nerve pathways leading to the characteristic speech pattern of spasmodic dysphonia.

When one reads the medical literature about spasmodic dysphonia, the notion that this disorder can be caused by psychological distress is soundly dismissed. But that is also the case for the rest of the MBS disorders. For example, those with chronic fatigue syndrome are insulted when this notion is broached and the recent study showing that psychotherapy can help chronic fatigue syndrome is criticized by the support groups that would rather be afflicted with a virus, that may be incurable than entertain the possibility of being able to reverse the severe fatigue by psychological means.

Reversing stuttering and spasmodic dysphonia is the same as for other manifestations of MBS. The first step requires a clear understanding that the symptoms are real; they are not imagined, nor are they produced willfully, but are created by powerful nervous system pathways that will continue to trigger symptoms until they are stopped. The second step is to realize that one can get better. This is not a genetic condition (there may be genetic predispositions, but these require environmental triggers to be expressed, and can be reversed). This is not a degenerative neurologic condition such as Parkinson’s disease. It is reversible, so there is the strong possibility that one can improve and reverse the condition with MBS treatment. The third step is to investigate the circumstances (starting with childhood events and carefully exploring the situations that triggered the symptoms) that created the speech problems. An open and detailed review of one’s life will generally make the connections quite obvious. A guide to this process is available in my book, Unlearn Your Pain (chapter 5).

Once these steps have occurred, it should be clear that the actual diagnosis is Mind Body syndrome and this usually releases a great deal of positive energy that is necessary to unlock the nervous system pathways that keep one stuck in the abnormal speech patterns (or other symptoms of MBS). The treatment program outlined in Unlearn Your Pain includes a variety of therapeutic writing exercises, meditative exercises, positive affirmations, and other exercises that are designed to help people reverse their symptoms. Conscious processes can override the learned nerve pathways and this is the beauty of treating MBS—the majority of people experience significant or dramatic improvements. As with King George, when one “finds their voice” they can reclaim their life.

Beach Girl mentioned the Structured Educational Program on the wiki (tmswiki.org). I would like to double-emphasize that as a great place to start. I had many different TMS symptoms over many years. Reading my first Dr. Sarno book made sense to me, but it wasn't until I started doing the SEP (and taking it seriously) that I started having a noticeable reduction of symptoms. I'm 90-100% symptom-free most of the time now (I could be 100% if I practiced more mindfulness!). In any case, it was a real life-changer.

You've been recommended for CBT - so your medical practitioners already think that the problem could be emotional. And you already know that emotionally-based physical symptoms, by Dr. Sarno's definition, are TMS. Also called by some practitioners MBS (Mind-Body Syndrome), or sometimes PPD (Psychophysiologic Disorders) or, to use a phrase that has fallen out of favor: psychosomatic illness. Take your pick - we're not talking about a black & white condition like, say, a broken bone, it's all kind of squishy when we're talking about the brain - literally :^)

What I'm trying to say is: if the medical pros think that CBT could help, then you might as well feel free to call it TMS, and I don't think that's a stretch!

One thing you will learn as you study the TMS resources is that CB therapists might not understand the emotional basis of TMS. Many of our members' back stories include trying CBT without a whole lot of significant success. That's not to say that a CB therapist can't include TMS treatment in their practice - it's just that many don't know about it (yet)(!)

Anyway, go ahead and try the Structured Ed Program - it's just reading and journaling, it's free, it can't hurt, and you will be taking action which in itself will feel good.

There's also a page on the wiki devoted to finding a TMS practitioner in your area, and as we discussed today on the Saturday chat, many of them are available to do therapy by phone - strange but true, and many people have found help that way.

Good luck, and keep us posted, we're rooting for you!

Jan

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Thank you all of you. Your replies have been so warm and welcoming. Thank you very much.
I do appreciate that CBT may not be as useful as I would like but its worth a try I suppose not least because its available on the NHS - I'm in the UK and for now healthcare is free, where available.

I've started to read Dr Sarno's book 'The MindBody Prescription' and am finding that I'm nodding a lot. Really a lot. The rage, the split of conscious and unconscious especially the one where on the one side I'm concerned for others and the opposite being self-involved and narcissistic. Made me smile because it's ring of truth for me is quite loud!

I will have a good look through the Structured Program on the wiki.
I'm going through so much emotionally at the moment due to the loss of my speaking voice and then reading Sarno's work I realise that I have a lot of work to do.

Thank you all of you. Your replies have been so warm and welcoming. Thank you very much.

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Well, we wish the absolute best for you. We've been there, too, so we know how hard and scary it is. But know this: you can recover. You've got the strength and if you keep doing the work, I have no doubt that you will get better.

Please keep us updated to let us know how it goes. We're all rooting for you!

Yes, Georgie Oldfield is particularly good and very dedicated. I think that once you've been diagnosed, she's willing to meet with you over the phone. Her new website is http://georgieoldfield.com/

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This is an old post but I will chime in. Without fail when I am stressed,or overly tired,I begin to lose voice volume and strength/it always goes away and I've never been concerned about it as I know others who get this. The most irritating thing is when I'm asked to speak up!

Dr. Howard Schubiner is a long time staunch supporter of the PPD / TMS Peer Network and at one point even offered to donate a portion of all proceeds from his online program to our nonprofit. We ended up declining his generous offer because we know how important it is to let the public know that we are completely financially independent of all PPD / TMS practitioners and represent only Peers with PPD / TMS, but the offer was gratefully appreciated (we need people to know that we recommend his program only because it is excellent and not because it diminishes our need to get donations from other sources). Because we are a volunteer run organization, our expenses are extraordinarily low, so it isn't that hard to raise the money that we need. In general, volunteer organizations take an extremely high amount of work to set up (for example, as of today, I've sent 4259 emails from the account that I use for TMS Wiki work. I've pretty much been working on this almost full time for three years), but once you've set them up, you've created something truly amazing. As you can see from the hard work of the volunteer Forum Support Team who run this forum, we've got an amazing team. They're the people with "administrator" or "Forum Support" below their pictures.

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How incredibly generous of Howard to make that offer but on balance you made the right call!
More evidence he has his heart in the right place. I suppose he realises the greater importance of trying to get the message out!